Munchausen’s syndrome

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McIlhoy suffered from Munchausen’s syndrome, the intentional production or feigning of physical or psychological illness for the purpose of assuming a sick role. This condition should not be confused with hypochondria, in which the person visits many doctor’s offices believing that he or she is sick. In Munchausen’s syndrome, the individual knows that illness does not exist but chooses to gain attention that cannot be realized in any other way.

R. Asher first described Munchausen’s syndrome in 1951 (Lancet 1951, 1, 339–341). The name came from Baron Karl Friedrich Munchausen (1720–1798), who told tall tales about his exploits as a soldier, hunter, and sportsman. When his stories were published in 1785, other authors picked up on them and exaggerated them even more. Gradually, his name became associated with amusing, preposterous tales or lies convincingly told. Munchausen’s name also became associated with people who fabricated tall tales of illness. Roy Meadow coined the term Munchausen’s syndrome by proxy (MSBP) in 1977 to refer to the intentional fabrication of the physical or psychological illness of a person under the individual’s care.

When “John” was 16 months old, his mother brought him to a clinic for vomiting, bleeding, diarrhea, seizures, and poor feeding. He had been admitted at two months for sleep apnea and at six months for seizures. A covert videotape showed the mother loving her child one minute and trying to suffocate him the next.

The diagnosis of MSBP is time-consuming, taking anywhere from 6 to 15 months. Determining the incidence and prevalence is difficult because no widespread population-based studies exist.

The incidence of MSBP in the general population is estimated to be 2–4 cases per million. Most perpetrators assume a “mother” role, and 90% are biological mothers. The mother may have had previous nursing or medical education, often not completed.

Diagnosis
A high index of suspicion is needed to make a diagnosis of MSBP. The signs include the following:

• most commonly, alleged allergies to a variety of foods or drugs;
• persistent or recurring illness that cannot be explained;
• discrepancy between clinical findings and the patient’s medical history;
• episodes that occur at home, never at school;
• a history of unnecessary absences from school;
• a mother who is overly attentive, refusing to leave the child’s bedside;
• a mother who has Munchausen’s syndrome or a personality disorder, such as narcissism; and
• a mother who is attached to the medical staff and is extremely helpful in care.

A hallmark of the syndrome is the cessation of symptoms when the child is separated from the mother. The mother appears tender, loving, and devoted to the child and thrives in a hospital setting. Usually, much turmoil exists in the marriage, and the father is usually not involved in care of the youngster.

An observant pediatrician may suspect a problem and involve other social agencies. MSBP qualifies as abuse under the Child Abuse Prevention Act of 1974. The court may remove the child and order psychological tests of the perpetrator.

Treatment
First, the person must admit deception and determine to correct the problem. In MSBP, theindividual must be monitored at all times and promise to keep the child with the same doctor; however, the prognosis is poor.

English physician David Southall used covert video to observe 33 mothers abusing their children. When confronted, one mother said that she thought if she did something drastic enough, someone would see how much she needed help. Although the condition is rare, it warrants attention and public awareness.

Further reading

AsherMeadow MSP Resource Center; www.ashermeadow.com

Center for Psychiatric Medicine, University of Alabama, Birmingham; www.munchausen.com.